Name *

First Name

Last Name

Phone *

(###)

###

####

How is your organization/initiative Black- or Brown-led? Select all that apply. *

Founder or Executive

Board of Directors

Advisors or Advisory Board

501c3 Leadership Staff

Other

Does your organization/initiative have 501c3 status? *

Yes

No

Does your organization/initiative have a fiscal sponsor? *

Yes

No

Is your budget at or under $50,000? *

Yes

No

When was your organization founded? *

MM

DD

YYYY

Will you be available to attend both Saturday, Nov. 1 and Sunday, Nov. 2, 2025 for the full schedule? *

Yes

No